“I don’t have insurance and I don’t want a lot of stuff done,” he said. “Can we hurry this up so I can get out of here?”
“You obviously need stitches, so let’s get you triaged,” Molly replied.
In the patient’s room, the physician’s assistant created a chart for the patient; like Molly, she documented that the patient was calm and co-operative. Then the patient made the mistake of talking back to the doctor, who had a low tolerance for drunk patients. “Doc, I want to get the fuck out of here!” he shouted. “Leave me the fuck alone.”
Molly liked this doctor, but he had a habit of giving a psychiatric diagnosis to intoxicated patients who disagreed with him. “This man is a harm to himself and needs chemical restraints,” he declared to the PA. “Give him twenty milligrams of Geodon,” an antipsychotic that put people to sleep. The PA refused.
“What, are you too lazy to put it in?” the doctor said.
“I don’t think it’s the right thing to do,” she said, uncomfortable. “He’s not psychotic. He just disagrees with you.”
The doctor was unruffled. “I thought we had a better working relationship than that,” he said. Not only did he put the order in, but, worse, he deleted the PA’s chart and started his own, in which he stated that the patient was combative and a harm to himself. It was the sort of behavior for which a doctor could lose his license. But even if Molly were to complain to administrators, which she did not, she expected the hospital would ignore her. It was as if the nurses’ voices didn’t matter.
Doctor Versus Nurse
Molly’s experiences with egotistical doctors are not atypical. In fact, they barely scratch the surface of an even more disturbing trend, a doctor-bully epidemic that one doctor described as lurking in the “shadowy, dark corners of our profession.”
In news reports and hospital break rooms, stories abound of doctors berating nurses, hurling profanities, or even physically threatening them: shoving matches in the operating room; a surgeon pushing a nurse so hard mid-operation that he left a bloody handprint on her scrubs; physicians throwing stethoscopes, scissors, pens, or surgical instruments. Physical abuse by physicians is on the rise. In Maryland, a surgeon yelled at a male nurse, “Are you stupid or something?” and threw a bloody surgical sponge at him from across the room. A Texas doctor heaved a metal clipboard at an advanced-practice nurse and told her he was going to strangle her. A surgeon threw a scalpel at a Virginia nurse, who said, “He was angry because I didn’t have a rare piece of equipment he needed, so he endangered me and several others by throwing a tantrum.” North Carolina nurses referred to one doctor as “He-Who-Must-Not-Be-Named,” because he got into a fistfight with another doctor and physically assaulted a nurse.
Most nurses have been victims of or have witnessed doctor bullying. The Institute for Safe Medication Practices (ISMP), a nationally respected nonprofit watchdog organization, has reported rampant bullying in healthcare, including verbal abuse, threatening body language, condescension, and, though less common, physical abuse. A 2013 ISMP survey on workplace intimidation found that in the preceding year, 87 percent of nurses encountered physicians/prescribers who had a “reluctance or refusal to answer your questions, or return calls,” 74 percent experienced physicians’ “condescending or demeaning comments or insults,” and one in four nurses had objects thrown at them by doctors. Physicians shamed, humiliated, or spread malicious rumors about 42 percent of the surveyed nurses. As a New York critical care nurse said, “Every single nurse I know has been verbally berated by a doctor. Every single one.”
This is a global problem. Significant numbers of nurses in Australia, South Africa, Hong Kong, Canada, and many more countries are bullied by doctors, according to surveys. In 2010, a nurse in India committed suicide reportedly because administrators would not address her complaints about a doctor who was sexually harassing her. A nurse’s association president said, “This case has not been taken seriously because the victim is a nurse.” In South Korea, a 2013 survey found that more than half of nurses were sexually harassed; the majority of the assailants were doctors.
Doctor bullying has many serious ramifications. A 2013 study found that the more that nurses experience it, the more likely they are to report poor working environments and to quit their workplace and/or the nursing profession. This is not the first study to find a link between doctors’ intimidation and poor nurse satisfaction, yet researchers repeatedly have found that most nurses don’t speak out against the behavior.
Why is hospital bullying veiled in organizational silence? Nurses are afraid to report doctors because they believe administrators will prioritize and refuse to penalize physicians who generate revenue or garner media accolades. They worry they might lose their own jobs in retaliation, and they fear the stigma of being perceived by colleagues as a whistle-blower.
If precedence is indicative, these fears are justified. A slew of double standards protect doctors’ jobs but hang nurses out to dry. Many hospitals have fired nurses for reporting doctors’ inappropriate or incorrect treatment of patients, while allowing the doctors in question to continue to practice.
In Florida, travel nurse C. T. Tomlinson saw Lawnwood Regional Medical Center cardiologist Abdul Shadani preparing to insert a stent in a heart patient although the patient’s scans revealed no arterial blockages. (A travel nurse is an agency nurse whose jobs are temporary assignments in various locales.) “Sir, what are we going to fix?” the nurse asked, according to a New York Times investigative report. Shadani said the patient had a 90 percent blockage and inserted the stent; Tomlinson told the Times that other staff in the room did not object. Soon after Tomlinson reported Shadani to HCA, Lawnwood’s parent company and the largest for-profit hospital chain in the United States, Lawnwood did not renew the nurse’s contract. An internal, confidential memo reviewed by the Times admitted the nurse’s contract was not renewed because of retaliation. HCA did, however, initiate an investigation that found issues with Shadani’s treatment of thirteen out of seventeen patients, including several other unnecessary procedures. Tomlinson was reportedly correct—and an ideal patient advocate, hoping to protect patient safety—but the hospital let him go. Meanwhile, at the time of this writing, Shadani still works at Lawnwood.
In 2009, two Texas nurses filed an anonymous ethics complaint with the Texas Medical Board against Dr. Rolando Arafiles Jr. for conducting dangerous practices that risked patient health, taking hospital supplies to perform at-home procedures, and pushing patients to purchase herbal supplements that he conveniently sold on the side. When the board informed Arafiles about the nurses’ complaint, Arafiles enlisted the help of the county sheriff, a friend and former patient who participated in his supplement business. At Winkler County Memorial Hospital, Arafiles tracked down personal information for the patients listed in the complaint and gave it to the sheriff, who contacted them to determine the nurses’ identities. The sheriff obtained a search warrant to seize the nurses’ computers, where he found the letter.
A hospital administrator fired both nurses, who had worked at the hospital for decades, and who had not signed their letter because they feared exactly this type of retaliation. They had resorted to filing the complaint after months of unsuccessful attempts to persuade hospital administrators to investigate the doctor. Worse, Arafiles and the sheriff convinced the county prosecutor to take the nurses to trial in criminal court, charging them with “misuse of official information,” a felony with a maximum penalty of ten years in prison and a $10,000 fine. Charges against one of the nurses were dropped and the other nurse was acquitted.